Provider Demographics
NPI:1083281018
Name:DEWEY, IAN THOMAS (BCBA)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:THOMAS
Last Name:DEWEY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 FOUNTAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5092
Mailing Address - Country:US
Mailing Address - Phone:817-385-7170
Mailing Address - Fax:
Practice Address - Street 1:1703 FOUNTAINVIEW DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5092
Practice Address - Country:US
Practice Address - Phone:817-385-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty